Vision Impairment and Its Management in Older Adults
K. Rao Poduri in Geriatric Rehabilitation, 2017
Eventually, if one lives long enough, everyone will develop a cataract that may or may not be visually significant. If one has blurring of vision, difficulty with glare, or requiring more light to read, they may have a cataract and should be evaluated by their eye doctor. At the doctor’s visit, your vision, need for glasses, eye pressure, density of cataract, retina, and optic nerve will be measured and examined. A cataract may make the eye more myopic or near-sighted and prescribing new glasses is all that may be needed. Alternatively, the ophthalmologist may determine whether the cataract is visually significant and requires surgical correction. If this is the case, measurements of the eye are taken to record the length of the eye, curvature of the cornea, and calculate the appropriate lens power of the implantable lens used as a replacement to the cloudy crystalline lens that is removed during cataract surgery. Other ocular pathology that may influence vision can also be identified with the preoperative evaluation. These include common diseases such as glaucoma and macular degeneration and less-common pathology such as Fuchs’ corneal dystrophy and pseudo-exfoliation syndrome, both of which are more common in older eyes. The latter two can lead to complications such as corneal edema and loss of zonular support and subsequent lens prolapse as well as small pupils, making cataract surgery challenging.
What Promotes Joy
Eve Shapiro in Joy in Medicine?, 2020
Ninety-nine percent of my patients have one or both of the conditions that are my subspecialties. One is cataract, which is cured by surgery; the other is glaucoma, which is managed but rarely cured. The procedures done by ophthalmologists are, by and large, scheduled at a convenient time, at the discretion of the patient, and usually are brief. Cataract surgery takes 10–15 minutes and glaucoma surgery can take 30–45 minutes, and they’re scheduled at elective hours, e.g., 9:00 a.m. on Tuesday. Since they’re of limited duration, the surgeon’s leg does not go numb while sitting in the operating room chair. Cataract surgery accounts for most of the surgeries I do. Patients elect to have cataract surgery when their vision is inadequate for their needs due to clouding of the natural lens of the eye. Surgery involves exchanging the cloudy lens for a clear artificial lens. Nearly all cataract patients do well and are happy and grateful.
Common Vitreoretinal Procedures
Pradeep Venkatesh in Handbook of Vitreoretinal Surgery, 2023
Up until the late 1980s, there continued to be raging debates on the safety of implanting IOLs after cataract surgery. Currently, cataract surgery occupies the very pinnacle of all surgeries in its ability to improve the quality of vision and quality of life. Hence, an eye without an intraocular implant after a planned cataract surgery is considered abnormal. To avoid this situation, all cataract surgeons endeavor to somehow implant an IOL into the eye. In more than 99% of the surgeries, IOL implantation is carried off successfully, either into the capsular bag or within the ciliary sulcus. In fewer than 1% of cases, however, an implanted IOL gets dislocated posteriorly, into the vitreous cavity. Surgical intervention is imperative in such situations because no visual rehabilitation would be possible otherwise.
Update on the management of uveitis in children: an overview for the clinician
Published in Expert Review of Ophthalmology, 2019
Lucas Kim, Alexa Li, Sheila Angeles-Han, Steven Yeh, Jessica Shantha
With certain complications, medical therapy will not suffice and surgical intervention is the subsequent step in management. Cataract surgery can be performed with visually significant cataracts. The decision whether to implant an intraocular lens, however, is a complex decision, as intraocular lens implantation may be associated with further posterior synechiae formation, subluxation of the intraocular lens with pupillary seclusion, chronic inflammation and pain, if the patient’s inflammation is poorly controlled in the perioperative period. If cataract surgery is needed, however, ophthalmologists should not proceed until intraocular inflammation is confirmed to be quiescent for at least 3 months [70]. Surgical intervention in the form of pars plana vitrectomy and lensectomy can be considered in complicated cases involving a miotic pupil, presence of cyclitic membranes, and dense vitreous opacities [71,72]. For pars planitis, surgical intervention via pars plana vitrectomy for epiretinal membrane formation, vitreous opacity, and tractional retinal detachment may be necessary [53]. For juvenile uveitic glaucoma refractory to medical therapy, goniosurgery and glaucoma drainage device implantation (e.g. tube shunt) may be required to achieve long-term control of intraocular pressure for the prevention of glaucomatous optic neuropathy [73,74].
Recent developments in the intraocular lens formulae: An update
Published in Seminars in Ophthalmology, 2023
Sarthak S. Kothari, Jagadesh C. Reddy
Cataract surgery is one of the most commonly performed ocular surgery. In a patient’s view success of cataract surgery is defined as obtaining a post-operative 20/20 refractive outcome with spectacle independence. The accuracy of refractive outcomes after uneventful cataract surgery largely depends on the biometry and intraocular lens (IOL) formula used for selecting the IOL.1 With the advent of optical biometers, there has been a flurry of technological advances, which has reduced biometry measurement errors to a minimum.1–3 However, there was little advancement in the field of IOL formulas until the recent decade. In recent 5 years, there has been an introduction of several new formulae for IOL power calculation to improve the accuracy of refraction outcomes in eyes undergoing cataract surgery.4,5 To improve the accuracy of post-op refractive outcomes, several methods of IOL power calculations like regression, vergence-based, ray-tracing, artificial intelligence, and hybrid have been used. This review would aim to summarise the principles of these formulae and their performance among normal and variable ocular biometry conditions.
Efficacy and safety of bromfenac 0.075% formulated in DuraSite for pain and inflammation in cataract surgery
Published in Expert Opinion on Pharmacotherapy, 2019
Scott M Wentz, Francis Price, Alon Harris, Brent Siesky, Thomas Ciulla
Cataract surgery is one of the most common outpatient surgeries performed in the United States. In 2015, it was estimated that 3.6 million surgeries were performed in the United States alone [1]. Cataract surgery is usually well tolerated; however, some patients do experience some discomfort during and after the procedure. Additionally, as with any intraocular anterior segment surgery, some inflammation is expected to result in the anterior segment of the eye. Having good control of the inflammation is crucial, as uncontrolled inflammation increases the rate of post-operative pseudophakic cystoid macular edema (CME) (i.e. Irvine-Gass Syndrome) [2–5]. CME typically leads to decreased visual acuity and decreased contrast sensitivity for the patient and can be chronic in some cases, although it is typically a self-limited condition. Much research has centered on mitigation or prevention of both the pain and inflammation associated with cataract surgery. This has resulted in approval of several ophthalmic medications to address pain and inflammation associated with cataract surgery. The scope of this Drug Evaluation will be to discuss BromSite (bromfenac sodium 0.075% in DuraSite vehicle), a relatively newly approved therapy with a novel vehicle that enhances treatment contact with the ocular surface, to treat pain and inflammation associated with cataract surgery.
Related Knowledge Centers
- Ambulatory Care
- Cataract
- Congenital Cataract
- Emulsion
- Eye
- Visual Acuity
- Lens
- Intraocular Lens
- Glare
- Ophthalmology